Li Haitao, Wang Liangshan, Liu Changcheng, Gu Chengxiong
Department of Cardiac Surgery, Beijing An Zhen Hospital of Capital Medical University, Beijing, People's Republic of China.
Center for Cardiac Intensive Care, Capital Medical University Affiliated Anzhen Hospital, Beijing, People's Republic of China.
Perfusion. 2022 May;37(4):410-416. doi: 10.1177/0267659120988811. Epub 2021 Mar 24.
The posterior descending artery is the most common vessel chosen for an endarterectomy, while endarterectomy to the posterior descending artery is associated with decreased graft patency. The purpose of this study was to describe a distal anastomosis support (DAS) technique and retrospectively investigate the effect of DAS on the mid-term graft patency.
Between January 2016 and December 2018, 200 patients with a PDA severe lesion who underwent off-pump coronary artery bypass (OPCAB) with CE (OPCAB + CE group, = 95) and OPCAB + CE with DAS for anastomosis of PDA grafted by saphenous vein (SVG) (OPCAB + CE + DAS group, = 105) were evaluated retrospectively. All patients came back to follow-up visit 6th, 12th, 24th, and 36th postoperative month. The primary endpoint is the graft failure (FitzGibbon B or O) of SVG-PDA on the follow-up CTA or CAG.
There was no significant difference in perioperative outcomes. We found significantly improved cumulative graft patency in OPCAB + CE + DAS group at 36 months after operation (84.6% vs 76.5%, p = 0.02). In multivariate Cox regression analysis, plaque length larger than 2 cm (hazard ratio [HR], 13.108, 95% confidence interval [CI], 2.842-60.457, p = 0.001), and peak TNI ⩾70× ULN within 48 hours of surgery (HR, 3.778, 95% CI, 1.453-9.823, p = 0.006) were independent predictors of graft failure, whereas PDA diameter greater than 1.5 mm (HR, 0.231, 95% CI, 0.081-0.654, p = 0.006), and DAS use (HR, 0.336, 95% CI, 0.139-0.812, p = 0.015) were significant protective factors.
Concomitant DAS conferred superior mid-term patency of SVG-PDA. Adding the DAS procedure to OPCAB + CE may be a promising surgical option for patients with a PDA severe lesion, especially when PDA diameter less than 1.5 mm and plaque length greater than 2 cm.
后降支动脉是内膜切除术最常选用的血管，而行后降支动脉内膜切除术与移植物通畅率降低相关。本研究的目的是描述一种远端吻合支撑（DAS）技术，并回顾性研究DAS对中期移植物通畅率的影响。
回顾性评估2016年1月至2018年12月期间200例患有后降支严重病变且接受非体外循环冠状动脉搭桥术（OPCAB）联合冠状动脉内膜切除术（CE）（OPCAB + CE组，n = 95）以及接受OPCAB + CE联合DAS用于大隐静脉（SVG）移植后降支动脉吻合术（OPCAB + CE + DAS组，n = 105）的患者。所有患者在术后第6、12、24和36个月进行随访。主要终点是随访CTA或CAG时SVG - PDA的移植物失败（FitzGibbon B或O）。
围手术期结果无显著差异。我们发现OPCAB + CE + DAS组术后36个月时累积移植物通畅率显著提高（84.6%对76.5%，p = 0.02）。在多因素Cox回归分析中，斑块长度大于2 cm（风险比[HR]，13.108，95%置信区间[CI]，2.842 - 60.457，p = 0.001）以及手术48小时内肌钙蛋白I峰值⩾70×ULN（HR，3.778，95% CI，1.453 - 9.823，p = 0.006）是移植物失败的独立预测因素，而后降支动脉直径大于1.5 mm（HR，0.231，95% CI，0.081 - 0.654，p = 0.006）以及使用DAS（HR，0.336，95% CI，0.139 - 0.812，p = 0.015）是显著的保护因素。
联合使用DAS可使SVG - PDA获得更好的中期通畅率。对于患有后降支严重病变的患者，尤其是后降支动脉直径小于1.5 mm且斑块长度大于2 cm的患者，在OPCAB + CE中增加DAS手术可能是一种有前景的手术选择。
